Which politician signed off on what primary care centre? How many will be public-private partnerships? Who’s funding them? What are they?
Actually, says Dr John Latham, a GP at Thomas Court Primary Care Centre in Dublin 8, most patients aren’t that interested in the finer details. “They don’t really care what a GP is paid for treating the under-sixes, or how primary care centres are built. As long as they get the service they need, that’s all they’re interested in, and quite rightly too.”
So, what will primary care centres actually mean for patients and communities all around Ireland?
What is a "primary care centre"? "Successive governments have had a policy for the development of primary care centres. The aspiration is that such centres would provide a one-stop shop for all of a patient's primary care needs such as a GP, physiotherapist, occupational therapist, counsellor and more," says Dr Padraig McGarry, chairman of the GP committee of the Irish Medical Organisation (IMO).
Primary care teams around Ireland include, at a minimum, community and public health nursing teams and home helps. They usually have some combination of mental health services, social workers, speech and language therapists, dental services and other health professionals.
What difference do they make? The idea is that each team, in each community, meets and consults the patients in their care. If a GP, nurse or physiotherapist needs better services for one of their patients, primary care teams mean they don't have to fill out a form, send it to an anonymous stranger in the morass of HSE bureaucracy, and hope that somebody eventually gets around to addressing their patient's need. Instead, they go to their colleague in the same building, and ask for it.
Say, for example, a physiotherapist picks up that one of their patients is experiencing mental health difficulties: they can talk to a psychologist on their team about it, and refer the patient to them if necessary. Or a public health nurse might find that a patientg with diabetes needs additional help and support, and can refer them onto a dietictian on their own primary care team. In theory, it's meant to speed up services for patients. What's the difference between a primary care team and a primary care centre – and what difference does this make to the patient? "While primary care centres are the physical buildings, primary care teams are a virtual approach, whereby the GP can refer to allied health professionals who might be operating from other premises," according to McGarry.
So it's basically about changing HSE bureaucracy? To some degree, yes. But it's also a tacit admission that centralised services don't work best for patients, and that local services delivered in communities by local, dedicated teams, tend to have better outcomes and keep people out of hospital. International evidence backs this up.
However, McGarry says there has been a lack of investment and proper planning for primary care, and there is an “inadequate” level of services due to insufficient numbers of allied health professionals, including physiotherapists.
Wait. How does a primary care centre keep people out of hospital? Firstly, by keeping people well. Doctors, nurses and other health professionals in primary care teams look at the needs of people in the local community and put a range of services, supports and classes in place.
If there are a lot of mothers with young babies in a community, the local primary care centre might run a breastfeeding support group, which also provides a crucial social outlet.
If there’s high unemployment, they might run reading and writing, yoga or exercise classes. If there’s an elderly population, they might have classes for people who could be at risk of falls. All of this, in theory at least, should reduce hospital admissions.
Secondly, people with illnesses or injuries can avail of local services without the need for a special trek to hospital. It's all about keeping them well in their own community. That's the idea, anyway, but the IMO claims that primary care centres are not affecting the numbers attending emergency departments. Is there one near me? Since March 2011, 44 HSE-funded primary care centres have opened. There are seven in Dublin, five in Cavan, four each in Meath and Cork, three in Galway, two each in Kildare, Kilkenny, Kerry, Louth, Leitrim and Roscommon, and one each in Laois, Longford, Westmeath, Wexford, Waterford, Limerick, Mayo, Wicklow and Donegal.
Most referrals come through hospitals, GPs, or a community or public health nurse. Other primary care centres, such as the Saffron and Blue Medical Clinic in Co Clare, have opened and are operating without State funding.
Many GPs have invested their own money in these centres; the IMO says there has been a lack of proper investment and planning for the resources required for primary care centres nationally, both in terms of the physical infrastructure required and the appropriate numbers of allied health professionals such as counsellors and physiotherapists.
A spokesperson for the IMO said that while it welcomes any investment in the development of general practice, it is concerned that it should take place in cooperation with local GPs, with appropriate and sustainable funding and the right level of support services.
Every primary care centre is mapped to an acute hospital as well as to psychiatric hospitals.
The Government says it wants to deliver 95 per cent of healthcare in the community, while the European Investment Bank has just announced it will invest €70 million in 14 new primary care centres.
The Government plans to develop 20 more.
Case study: Thomas Court Primary Care Centre
Thomas Court Primary Care Centre, situated in the heart of the Liberties in Dublin 8, opened three years ago after moving from a much smaller premises on a nearby street.
This is a relatively working-class area which, with the development of numerous apartment blocks, has also drawn in a substantial middle class and non-Irish or newcomer population. Still, about 90 per cent of patients attending GP services at the health centre hold medical cards.
The centre is a four-storey building, situated beside the picturesque St Catherine's Church.
It accommodates three primary care teams, one each from Rialto, the Coombe and St James's – each covering a population of about 10,000 people.
As well as a physiotherapy gym, there are GPs, nurses and consulting rooms for various professionals. They also link in with the National Diabetic Retinopathy Screening Service.
On the third floor, a multidisciplinary team made up of community nurses, a physiotherapist, an occupational therapist, social worker and GPs meets to discuss the needs of local patients in their care.
There's also support from dietitians, home helps, speech and language therapists and counselling psychologists who tend to work across the three teams.
In the nearby Meath Primary Care Centre, there's also a dental service.
Gillian Farrelly, the primary care manager for Dublin South City, says the centre receives a significant number of referrals from St James's, the local acute hospital. "If a patient is returning home, the hospital will contact us to make sure they have the support in their community," she says.
Jenny Clarke, an occupational therapist on the Rialto team, says better communication between health professionals is leading to better patient and client care.
"We can find each other easily. There's a sense of working together in a team. Every one of us asks our clients or patients to liaise with colleagues around their care."
Dr John Latham has served as a GP in this community for more than 30 years and is now based in the Thomas Court centre. He says that while not every GP should be based in a primary care centre, it has worked well for him and is the right model for this community.
"Before, GPs were often isolated and forgotten by other services. Now, we're all advocating for the same set of patients. This has made a huge difference."
